Tag Archives: Childhood Trauma Fact Sheet

What Is Mindfulness?

MINDFULNESS is an exciting technique, its effectiveness supported by much research evidence, which is now becoming very popular as a tool for the treatment of conditions related to childhood trauma, including depression, anxiety, difficulties regulating emotions and borderline personality disorder (BPD). It derives from Buddhist philosophy.

The technique teaches people to improve their coping ability and resilience by concentrating on :

– how they breathe

– observing

– accepting

– adopting a non-judgmental attitude

Individuals are encouraged to just accept and observe their thoughts, their physical sensations (perhaps caused by anxiety) and their emotions as they come and go in the mind.

The technique emphasizes the importance of just observing these phenomenon in a detached way, stepping back from them, avoiding engaging with them or getting caught up in them. A metaphor for this would be watching leaves on a stream float by.

Mindfulness is also all about being intensely involved in the MOMENT (rather than thinking about the past or future). It is about accepting the moment as it is and being fully involved in it – for example, becoming aware of our breath going in and out, the feel of the temperature on our skin, the feel of the seat we are sitting in, the feel of the clothes against our skin, the colour of the walls – everything, in fact, which is currently impinging upon the senses. By existing in the moment, unconcerned by the past or present, we can just dispassionately, non-judgmentally ‘watch’ our concerns and worries as they pass through our mind.

In this way we can detach ourselves from stressors, and, with practice, we can prevent our previously unhelpful, ‘automatic responses’ to stress. The technique also encourages us, as we simply observe, in a detached manner, thoughts and feelings passing through our minds, to label them. For example, ‘worry’, ‘fear’ etc; the reason for this is explained below:

NEUROLOGICAL EXPLANATIONS ABOUT WHY MINDFULNESS WORKS:

As I have already said, there is a lot of evidence showing MINDFULNESS to be a very effective coping technique. In terms of how the brain works, this has been explained in the following way: – labelling our emotions rather than engaging with them activates the PREFRONTAL CORTEX (an area of the brain) which reduces anxiety – a high level of MINDFULNESS correlates positively with the level of neural activity in the PREFRONTAL CORTEX; this has the effect of dampening down acivity in the AMYGDALA (high activity in the brain area known as the AMYGDALA is associated with intense emotions); in this way, we become much calmer. – the effects of practicing MINDFULNESS, and the subsequent effects on the brain given above, result in us being able to achieve much greater emotional regulation (emotional control).

As well as reducing anxiety, depression and helping us to master our emotions, MINDFULNESS, research has shown, also benefits the immune system, helps people control obsessive-compulsive disorder (OCD) and is also used to help control chronic pain. Furthermore, people who continue to practice mindfulness have been found to have stronger coping skills and greater resilience than others.

DIALECTICAL BEHAVIOR THERAPY (DBT) is an exciting new treatment option for those suffering with BPD. It is a therapy which has elements in common with cognitive behavioral therapy (CBT).

It is an evidence-based treatment (ie it is backed by scientific research).

In the past, BPD was considered to be extremely difficult to treat, but, with the development of therapies such as CBT and DBT, the prognosis is now far more optimistic.

DBT was originally created by the psychologist Marsha Lineham; at first, it was developed with the treatment of females who self-harmed and were suicidal in mind. However, since then, its possible applications have become much broader; it is now used to treat both males and females suffering from a large array of different psychological conditions.

As already stated, DBT has many elements in common with CBT; in addition to this, it also borrows from ZEN and a therapy, which is becoming increasingly popular, called MINDFULNESS.

DBT has been particularly successful in the treatment of BPD (for information about BPD see Category 3 of the main menu : BORDERLINE PERSONALITY DISORDER AND ITS RELATIONSHIP TO CHILDHOOD TRAUMA). It is thought that one of the main CONTRIBUTING FACTORS of BPD is a traumatic childhood in which the child grows up in an INVALIDATING ENVIRONMENT (eg made to feel unloved and worthless). Such a childhood environment is especially likely to result in the child developing BPD in later life if he/she also has a BIOLOGICAL VULNERABILITY (carries certain genes making him/her particularly vulnerable to stress).

When a person is suffering from BPD the condition causes him/her to REACT WITH ABNORMAL INTENSITY TO EMOTIONAL STIMULATION; the individual’s level of emotional arousal goes up extremely fast, peaks at an abnormally high level, and, takes much longer than normal to return to its baseline level.

This condition leads to the affected individual – a victim of his/her uncontrollable, intense emotional reactions – prone to stagger in life from one crisis to the next and to be perceived by others as emotionally unstable. It is thought that, due to the invalidating environment which the sufferer experienced in childhood, the normal ability to develop the coping strategies needed to regulate emotions is blocked, leaving the person defenceless against painful emotional feelings and leading to maladaptive (unhelpful) behaviors.

It is this problem which DBT was is now used to address. The therapy teaches individuals how to cope with, and regulate, their emotions so that they are no longer dominated and controlled by them. This is vital as the inability to control feelings will often wreck crucial areas of life, including friendships, relationships and careers. It is because of these possible effects that DBT also helps individuals develop SOCIAL SKILLS to help reduce the likelihood of them occurring.

DBT has been found to be effective in helping people suffering from a large range of psychiatric conditions; these include;

What Happens When We Try To ‘Fight’ Anxiety?

Trying to fight anxiety, research suggests (and, certainly, my own experience of anxiety would tend to confirm this) can actually AGGRAVATE the problem and lead to greater feelings of distress. Stating the shatteringly obvious, none of us wants to experience the feelings an anxiety condition brings; however, difficult as it may sound at first, DEVELOPING AN ATTITUDE OF ACCEPTANCE TOWARDS IT, rather than entering an exhausting mental battle with it, has been reported by many to be a superior strategy for coping with anxiety.

The psychologist Beck, to whom I have made several references already in this blog (he was one of the founders of the very helpful therapy called Cognitive Behaviour Therapy, or CBT, for people suffering from conditions such as depression and anxiety – see my posts on CBT) devised the acronym A.W.A.R.E for ease of remembering the key strategies for coping. Let’s take a look at what the acronym A.W.A.R.E stands for:

A Accept the anxiety (it sounds hard, I know, but so is constantly struggling to fight it):

The benefits of adopting this approach are that it may help to reduce the PHYSIOLOGICAL symptoms commonly associated with anxiety (eg accelerated heart rate, increased muscle tension, hyperventilation, sweating -or ‘cold sweats’- trembling, dry mouth etc). It may, too, help with PSYCHOLOGICAL symptoms (people report that an attitude of acceptance towards their anxiety makes them feel less distressed). A kind of motto which has come to attach itself to the acceptance approach to anxiety is: ‘if you are not WILLING to have it, you WILL’ (see what they’ve done there!)

W Watch your anxiety:

It is suggested that rather than get too ‘caught up’ in anxiety, together with all the distressing negative thoughts and fears it produces, to, instead, just observe it in a DETACHED and NON-JUDGMENTAL manner; this involves trying to adopt a kind of NEUTRAL MENTAL ATTITUDE towards it – in other words, neither liking it nor seeing the experience of anxiety as a terrible, unsolvable catastrophy (again, I realize, of course, that intense anxiety is very painful, so this, too, may sound difficult at first). People report that when they adopt this DETACHED, NEUTRAL view of their feelings of anxiety they starts to lose their, hitherto, tenacious grip on their lives.

A Act with your anxiety:

Severe anxiety can leave us feeling as if we are incapable of functioning on even a basic level. It is important to remember, however, as I have repeated at, no doubt, tedious length througout this blog, that just because we believe something it does not logically follow that the belief must be true. Indeed, when my anxiety was at its worst, I did not feel able, or even believe I could,shave or brush my teeth etc…etc… Many people report, however, that if they take the first (often, extremely challenging) step to try to carry on with normal activities, despite the feeling of anxiety which may accompany this, they can, after all, accomplish that which they originally believed they couldn’t. Success then tends to build upon success: completion of the first activity increases the self-belief and the confidence to go on to the second activity, the completion of which provides further self-belief and confidence…and so on…and so on…

In order to make this easier, it may be necessary to slow down the pace at which, in different circumstances, we would otherwise carry out the particular tasks that we set ourselves.

R Repeat the steps:

This just means that by repeating the ACCEPTING ANXIETY, WATCHING OUR ANXIETY (in a detached and neutral manner) and ACTING (despite the feelings of anxiety which may accompany such action) CYCLE, the anxiety may be slowly eroded away.

E Expect the best (even if it does not come naturally)

When we are depressed and anxious we, almost invariably, expect the worst. This is overwhelmingly likely to perpetuate the condition. However, just as expecting the worst can become a self-fulfilling prophecy, so, too, can expecting the best. If, like me, you are not a natural optimist, the concept of expecting the best may go against the grain. However, research shows that optimistic people are more likely to achieve their goals than those of us who do not appear to have been blessed with quite such a sunny disposition. It is worth adapting the strategy on, at least, an experimental basis. It is also useful to keep in mind that even if the best does not occur, we will still have the inner-strength necessary to cope.

eBook :

Above eBook now available for immediate download on Amazon. CLICK HERE.

It is always important to treat post-traumatic stress and this is particularly the case in relation to childhood trauma. This is because it is during childhood that we form our core beliefs about ourselves, others and the world in general. Childhood trauma can severely distort these beliefs in a highly destructive manner. Without treatment, these damaging views and beliefs can endure for a life-time, blighting the entire life of the affected individual, even ruining it.

Cognitive Processing Therapy (CPT) is a particular type of Cognitive Behaviour Therapy (CBT) and there is now much evidence from research studies that it can prove highly effective in the treatment of the effects of trauma:

Frequently, individuals who have suffered childhood trauma find themselves in a perpetual and distressing struggle with painful memories. Thoughts about these often become circular and overwhelming, never reaching a resolution. The person experiencing them can feel more and more conflicted as time goes on if effective treatment is not sought.Indeed, many who seek therapy do so because they find they have become ‘stuck’ or ‘caught up’ in their painful thoughts, memories and feelings and they feel unable to properly integrate or make sense these.

CPT helps people to understand what they went through, how it affected them, and how it has affected, in a negative and distorted way, their view of themselves, others and the world in general (psychologists refer to such thinking as a ‘negative cognitive triad’, one of the key symptoms of clinical depression).

CPT aims to help individuals rectify this negative cognitive triad and gain AUTHORITY over their trauma-related memories and feelings, or, to put it another way, CPT helps people to be IN CONTROL OF THEIR MEMORIES AND RELATED FEELINGS, rather than the other way around.

Many individuals who have experienced childhood trauma, also, very frequently, find themselves ‘living in the past’: continually brooding on what happened, why it happened and how it has adversely affected their lives; such ruminations may become obsessive. CPT helps break this pattern of thinking: one of the key elements of CPT is to help people CREATE A BOUNDARY BETWEEN THE PAST AND THE PRESENT so that the individual can free him/herself to finally live in the ‘now’ rather than the ‘then’.

For more information about CBT and help for recovery from trauma a good site is: http://www.psychologytools.org/ptsd.html

Because I found CBT very useful in my own recovery, and, additionally, because it has a very solid evidence base showing that it is an effective therapy, I have listed links to two online CBT courses below :

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I had been perplexed for a very long time, given the emotional symptoms I was experiencing, which, it had always been obvious to me, were in large part related to my childhood experiences, why I had never been offered therapy, by the NHS, which could specifically address this issue. In fact, the professionals I had seen, incuding GPs and psychiatrists, rarely, if ever, asked me about my childhood, nor did they seek, in any way that I could ascertain, to link my symptoms to it. I can only assume that therapy addressing emotional problems which are linked to childhood experiences are deemed to be too expensive; perhaps it relates to where you happen to live, as different regions have different budgeting priorities. I know, though, that such therapies are available.

MEDICAL MODEL :

It is a common problem. In the UK, mental illness is almost invariably addressed using the MEDICAL MODEL (ie drugs are used to alter brain biochemistry). Some studies have shown, however, that anti-depressants work no better than PLACEBOS. We must ask, then, if, in many cases, treating mental illness with drugs is simply inappropriate? Would it not be better, in a lot of cases, to address the root cause of the symptoms -childhood trauma and/or other relevant life experiences?

PSYCHODYNAMIC AND PSYCHOANALYTIC PSYCHOTHERAPY:

These tharapies both seek to address root causes of adult psychological difficulties. Many of my posts have already discussed the fact that childhood trauma, very often, lessens (often, through physiological effects on the brain) the individual’s ablility to cope with stress in adult life. Here is a recap of symptoms childhood trauma can lead to:

Clearly, such difficulties can cause the individual severe distress, so it is important to investigate ALL the possible treatment options.

Psychodynamic and psychoanalytic psychotherapy aims, as I have already said,to address the root cause of distressing psychological symptoms: they are based upon the idea that we all SUPPRESS (ie bury deep down in the mind) feelings that, if they were allowed full access to consciousness, would OVERWHELM us with ANXIETY and EMOTIONAL PAIN. However, this requires psychological effort, and, in order to keep them suppressed, we must employ DEFENSE MECHANISMS (these may be employed both on conscious and unconscious levels). Examples of such defense mechanisms are PROJECTION and REACTION FORMATION:

– PROJECTION: this refers to how we EXTERNALIZE things we dislike about OURSELVES. For example, someone who is (needlessly) ashamed of being homosexual may go around calling everybody else ‘gay’ (using the word in a perjorative sense, of course)

– REACTION FORMATION: here, the individual feels the need to constantly proclaim s/he is not what, deep down, perhaps unconsciously, s/he feels s/he actually is. For example, someone who suppresses their aggressive instincts may feel the need to constantly proclaim how peace loving they are and how incapable of inflicting physical harm on others. In Shakespeare’s play, HAMLET, Iago seems to be aware of this psychological concept of reaction formation when he states, heavy with insinuation: ‘Methinks she protests too much’. Indeed, many of Freud’s ideas were anticipated in Shakespeare’s works.

There are other defense mechanisms which would take up too much space to go into here, but they all involve CUTTING OURSELVES OFF FROM OUR TRUE FEELINGS or trying to banish them in other ways, due to real, or perceived, societal and cultural demands.

It is thought that the MORE PAINFUL AND DIFFICULT KEEPING THE FEELINGS SUPPRESSED IS, THE MORE PSYCHOLOGICAL EFFORT THE MECHANISM OF SUPRESSION TAKES UP, and, therefore, THE MORE INTENSE THE REPERCUSSIONS, OR COSTS, IN TERMS OF PSYCHOLOGICAL SYMPTOMS, ARE (see list above for examples of these symptoms).

Psychotherapy aims to get us in touch with the feelings we are suppressing and work through them; some types of psychotherapy aim to bring what is buried in the unconscious into conscious awareness to enable such a process.

TYPES OF THERAPIES AVAILABLE:

1) SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPY: this usually consists of about 20 sessions spread over 20 weeks.

2) PSYCHOANALYTIC PSYCHOTHERAPY: this can consist of 2 or 3 sessions per week. There is no time limit – as many sessions are provided as required.

3) PSYCHOANALYSIS: this can comprise up to 5 sessions per week. Again, there is no time limit and as many sessions are provided as required.

By working through suppressed feelings (such as anger or fear) with the therapist, the rationale is that the past gradually loses its grip on the present, and, thus, its power to cause continued suffering.

DOES IT WORK?

Certainly, if considering such therapy, great care is needed when selecting a suitable therapist (eg checking their training, success rate, recommendations etc) as it is possible the treatment can do more harm than good if not properly implemented.

The psychologist, Hans Eysenck, argued that patients who underwent psychoanalysis recovered from their psychological difficulties no better than untreated controls. HOWEVER, there is, in fact, plenty of research which SUPPORTS its effectiveness; for example: Roth et al (1996) and, also, Holmes et al (1995).

One outcome of childhood trauma can frequently be that the person who has suffered it is prone to develop IDENTITY PROBLEMS.

A person’s identity represents their attempt to pin down the essential elements s/he sees (rather than what others see) that make the individual who s/he are. One’s identity develops over time.

Our identity can be helpful to our psychological health (if we see ourselves in largely positive terms) or unhelpful to it (if we see ourselves in largely negative terms). People, especially if suffering from depression, lacking in confidence etc, extremely often view themselves FAR MORE NEGATIVELY THAN WOULD BE OBJECTIVELY WARRANTED; whereas many others (not suffering from mental illness, in many cases) may see themselves in far too glowing terms (this ‘over self-congratulatory’ view adopted by many is thought to have developed to confer evolutionary advantages on those who have it – appearing confident to potential mates, for example – provided, I suppose, it is not absurdly exaggerated).

The identity which emerges from such factors is strongly related to our self-esteem and self-confidence.

IDENTITY DEVELOPMENT:

This begins very early in our lives. Ages 4 years to 6 years are thought to be a critical time; TRAUMA during this period is LINKED to the DEVELOPMENT OF IDENTITY PROBLEMS IN LATER LIFE. From the ages of about 6 years to 12 years, the child normally develops the skills necessary to MANAGE EMOTIONS, a skill strongly linked to identity (eg ‘cool’ versus ‘volatile’); indeed, if TRAUMA INTERFERES WITH THIS PROCESS AN EXTREMELY TEMPESTUOUS ADOLESCENCE CAN FOLLOW).

In ‘normal’ development, adolescents may experiment with various identities and this process gradually leads to the stage in which there is a sense of the identity becoming crystallized. Again, however, individuals affected by trauma will often find this period exceptionally stressful and find that NO CLEAR SENSE OF THEIR OWN IDENTITY EMERGES – THEIR SENSE OF THEIR OWN IDENTITY CAN BE CONFUSED AND THEY MAY FEEL THAT THEY ‘DON’T KNOW WHO THEY REALLY ARE’.

CONFUSED IDENTITY IN ADULTHOOD AS A RESULT OF CHILDHOOD TRAUMA:

By adulthood, then, those who have experienced childhood trauma will often find that their identity is UNSTABLE and FRAGILE – this will often mean that their attitudes, values and sense of who they are are all prone to wildly fluctuation; these changes are frequently dramatic (eg oscillating between feeling deep love and deep hatred towards the same person; or, sometimes, perhaps, feeling exceptionally important only to shift without warning or obvious trigger into a feeling of despair, self-loathing and worthlessness).

IDENTITIY PROBLEMS AND BORDERLINE PERSONALITY DISORDER (BPD):

Identity problems in adulthood are often a symptom of BPD. BPD frequently occurs as a result of childhood trauma and much more about the condition can be discovered in the by clicking here to read my article about it.

DEVELOPING A MORE CONSISTENT AND STRONGER SENSE OF ONE’S IDENTITY:

How can people with identity problems make their sense of identity stronger? One possible place to start this process, which needs to be gradually worked on over time, is for the individual suffering from the crisis in identity to consider the things which are of most importance to him/her in life; identities are largely formed based on these considerations. Prorities in life which people choose to concentrate on, and, which, therefore, contribute to making up their identities include:

This is not, of course, an exhaustive list and there may well be other areas that can be added, depending on preferences.

A starting point might be to pick out 3 or 4 areas of interest (this, in itself, reflects identity, and, therefore, can be seen as providing foundational pieces of the jig-saw yet to emerge, as it were) and to concentrate on these at first (other elements can be added later; merely starting the process may lead to other ideas emerging at a later time).

For each of the factors selected, it can then prove of use to set some goals relating to how these areas may be incorporated, or, more fully incorporated, into one’s life (these goals need to be quite specific and achievable; there is little point starting with such challenging goals that they may prove impossible to meet and thus damage morale).

Here are some examples:

– because academic achievement is important to me, I will enrol in a night-school class (investigate and specify appropriate course) and complete the course
– because family and/or friends are important to me I will attend an anger management course
– because creativity is important to me I will set aside two hours a week to write poetry/novel
– because my mental health is important to me I will seek out appropriate counselling and complete the sessios recommended (provided the therapy proves of potential value, of course)

The more the individual is able to incorporate and develop areas such as those listed above, which reflect his/her true values, interests and priorities, the more AUTHENTIC and REWARDING the person’s life is likely to be; the more, too, will the individual’s true and stable sense of self continue to evolve.

Individuals who have suffered severe childhood trauma may, as a result of it, later suffer from Post-Traumatic Stress Disorder (PTSD),or similar condition. Some professionals advocate a relatively new technique which aims to address this; it is known as Eye Movement Desensitisation and Reprocessing (EMDR).

WHAT IS EMDR?

The therapist administering EMDR will first examine the issues related to the individual’s psychological difficulties and, also, help him/her develop strategies to aid in relaxation and deal with stress. After this, the therapist encourages the individual to recall particular traumas, whilst, simultaneously, manipulating his/her eye movements by instructing him/her to follow the movements the therapist is making with a pen, or similar object, in front of the individual’s face). The theory is that this will facilitate the individual in effectively reprocessing his/her traumatic experiences, thus alleviating psychological distress.

THIS SOUNDS A LITTLE ODD; WHAT IS THE RATIONALE BEHIND EMDR AND, HOW, EXACTLY, IS IT THOUGHT TO WORK?

My first reaction to hearing about this particular therapy was that it sounded somewhat strange. However, the rationale behind EMDR is that disturbing memories from childhood need to be PROPERLY PROCESSED by the brain in order to alleviate symptoms associated with having experienced childhood trauma (eg PTSD, as already mentioned); this is because the view is taken that it is the UNRESOLVED TRAUMA that is the cause of the psychiatric difficulties the individual who presents him/herself for treatment is suffering. Those professionals who recommend the therapy believe that the EYE MOVEMENTS INDUCED BY THE THERAPIST IN THE INDIVIDUAL BEING TREATED LEAD TO NEUROLOGICAL AND PHYSIOLOGICAL CHANGES IN THE BRAIN WHICH AID IN THE EFFECTIVE REPROCESSING OF THE TRAUMATIC MEMORY, and, in this way, ameliorates psychological problems from which the individual had been suffering.

WHAT ARE THE STAGES INVOLVED IN EMDR THERAPY?

These are briefly outlined below:

1) The first stage is the identification of the specific memory/memories which underlie the trauma.

3) Then, the individual being treated is asked to replace the negative belief with a positive belief (e.g .’I am strong enough to recover’ or ‘I am a person of value with potential to have a bright future’ etc)

4) In the fourth stage, the therapist moves a pen (or similar object) in various, predetermined motions in front of the individual’s face and he/she is instructed to follow the movements with his/her eyes (e.g repeatedly left and right). Whilst this is going on, the therapist instructs the individual to simply, non-judgmentally observe his/her own thoughts, letting them come and go freely and without trying to influence them in any way – just to accept them, in other words, and let them happen.

5) This procedure is repeated several times.

Each time the process is undertaken, the therapist asks the individual being treated to rate how much distress he/she feels – this continues until his/her self-reported level of distress becomes very low. Similarly, each time the process is undertaken, the individual is asked to report how strongly he/she now feels he/she believes in the positive idea given in stage 3 (see examples provided above); therapy is only concluded once the level of reported belief becomes very high.

N.B. The therapy is actually more involved than this, so the above should only be taken as a brief outline. There are, too, different variations of procedure outlined above which can be employed within the EMDR range of therapies available.

EMDR CAN HELP UNBLOCK TRAUMATIC INFORMATION HELD IN THE BRAIN AND HELP US TO HEALTHILY INTEGRATE IT INTO OUR LIFE STORY AS A WHOLE :

When we suffer severe trauma we are not able to fully mentally process what it is that has happened to us and the trauma becomes mentally entrenched – in other words, what happened to us becomes locked or ‘stuck’ in our memory network. The effect of this may include us experiencing various symptoms such as irrational beliefs, painful emotions, anxiety and fears, flashbacks, nightmares and phobias. It may well also cause blocked energy and greatly reduce our self-efficacy.

When we experience events that trigger memories of the trauma, images, sounds, physical sensations and beliefs which echo the original experience of the trauma cause our perception of current events to be distorted.

EMDR (Eye Movement Desensitization and Reprocessing) can unblock this traumatic information and thus allow us to healthily mentally integrate it with our other life experiences and our life story as a whole.

Trauma can occur in the form of SHOCK TRAUMA and DEVELOPMENTAL TRAUMA. Shock trauma consists of a sudden threat which is overwhelming and/or life threatening – it occurs as a single episode such as a violent attack, rape or a natural disaster. Developmental trauma, on the other hand, refers to a series of events which occur over a period of time. These events GRADUALLY ALTER THE PERSON’S NEUROLOGICAL SYSTEM to the point that it REMAINS IN THE TRAUMATIC STATE. This, in turn, can cause interruption in the child’s long-term psychological growth. Experiences which can lead to developmental trauma include : abandonment by parent, long term separation from parent, an unsafe environment, an unstable environment, neglect, serious illness, physical and/or sexual abuse or betrayal by a care giver.

The effects of developmental trauma include damaging the child’s sense of self. self-esteem, self-definition and self-confidence. Also, the child’s sense of safety and security in the world will be seriously undermined. This makes it far more likely that the individual will experience further trauma in life as an adult as his/her sense of fear and helplessness remain unresolved.

EMDR works by allowing the locked or ‘stuck’ traumatic information to be properly, mentally processed. This leads to the disturbing information becoming psychologically resolved and integrated.

HOW DOES EMDR ACTUALLY WORK?

EMDR is based on the idea that it is our memories which form the basis of our PERCEPTIONS, ATTITUDES and BEHAVIOURS. Because, as we have already established, traumatic memories fail to be properly processed they lead to these perceptions, attitudes and behaviours becoming DISTORTED and DYSFUNCTIONAL. In effect, the trauma is too large and too complex to be properly processed so it remains ‘STUCK’ and DYSFUNCTIONALLY STORED. This often leads to MALADAPTIVE ATTEMPTS TO PROCESS AND RESOLVE THE INFORMATION CONNECTED TO THE TRAUMA SUCH AS FLASHBACKS AND NIGHTMARES (Sharpio, 2001).

When this problem occurs it is EMDR which is being increasingly turned to allow effective processing and mental healing to occur. I will look in more detail at what EMDR involves in later posts.

WHAT DO EVALUATION STUDIES OF EMDR THERAPY SUGGEST ABOUT ITS EFFECTIVENESS?

A recent meta-analysis of evidence (ie an overview of a large number of particular, individual studies of EMDR) supported the claim that it is effective, as have other meta-analyses. However, some researchers have suggested that it is not the EYE MOVEMENT PART of the therapy which is of benefit, but only the act of repeatedly recalling traumatic memories which is the effective component (based on the idea that these repeated mental exposures, under close supervision and in a supportive and safe environment, of the traumatic memories alone facilitates their therapeutic reprocessing).

In response to this criticism, its exponents (and there are many professionals who are), regard the EYE MOVEMENT COMPONENT of the therapy as ESSENTIAL in giving rise to the NECESSARY NEUROLOGICAL CHANGES which allow the EFFECTIVE REPROCESSING OF THE TRAUMA; these proponents also emphasize that the therapy only requires short exposures to the traumatic memory/memories, thus giving it an advantage over therapies which utilize far more protracted exposures.

Research into EMDR is ongoing.

eBooks :

Both above eBooks available on Amazon for immediate download. CLICK HERE.

Childhood Trauma And Psychopathy

What is the nature of the relationship between childhood trauma and psychopathy?

The term ‘psychopath’ is often used by the tabloid press. In fact, the diagnosis of ‘psychopath’ is no longer given – instead, the term ‘anti-social personality disorder’ is generally used.

When the word ‘psychopath’ is employed by the press, it tends to be used for its ‘sensational’ value to refer to a cold-blooded killer who may (or may not) have a diagnosis of mental illness.

It is very important to point out, however, that it is extremely rare for a person who is suffering from mental illness to commit a murder; someone suffering from very acute paranoid schizophrenia may have a delusional belief that others are a great danger to him/her (this might involve, say, terryfying hallucinations) and kill in response to that – I repeat, though, such events are very rare indeed: mentally ill people are far more likely to be a threat to themselves than to others (eg through self-harming, substance abuse or suicidal behaviours).

The word psychopath actually derives from Greek:

psych = mind

pathos = suffering

Someone who is a ‘psychopath’ (ie has been diagnosed with anti-social personality disorder) needs to fulfil the following criteria:

Often, psychopaths will possess considerable charisma, intelligence and charm; however, they will also be dishonest, manipulative and bullying, prepared to employ violence in order to achieve their aims.

As ‘psychopaths’ reach middle-age, fewer and fewer of them remain at large in society due to the fact that by this time they are normally incarcerated or dead from causes such as suicide, drug overdose or violent incidents (possibly by provoking a ‘fellow psychopath’ to murder them). However, it has also been suggested that some possess the skills necessary to integrate themselves into society (mainly by having decision making skills which enable this and operating in an context suited to their abilities, for example where cold judgment and ruthlessness are an advantage) and become very, even exceptionally, successful; perhaps it comes as little surprise, then, that they are thought to tend to be statistically over-represented in, for example, politics and in CEO roles (think Monty Burns from The Simpsons, though I’m aware he’s not real. Obviously.).

WHAT KINDS OF CHILDHOODS HAVE ADULT ‘PSYCHOPATHS’ HAD?

Research shows that ‘psychopaths’ tend to be a product of ENVIRONMENT rather than nature – ie they are MADE rather than born. They also tend to have suffered horrendous childhoods either at the hands of their own parent/s or those who were supposed to have been caring for them – perhaps suffering extreme violence or neglect.

Post-mortem studies have revealed that they frequently have underdeveloped regions of the brain responsible for the governing of emotions; IT APPEARS THAT THE SEVERE MALTREATMENT THAT THEY RECEIVED AS CHILDREN IS THE UNDERLYING CAUSE OF THE PHYSICAL UNDERDEVELOPMENT OF THESE VITAL BRAIN REGIONS. It is thought that these brain abnormalities lead to a propensity in the individual to SEEK OUT RISK, DANGER and similar STIMULATION (including violence).

IS THE PSYCHOPATHY TREATABLE?

Whilst there are those who consider the condition to be untreatable, many others, who are professionally involved in its study, are more optimistic. Indeed, some treatment communities have been set up to help those affected by the condition take responsibility for their actions and face up to the harm they have caused. Research is ongoing in order to assess to what degree intervention by mental health services can be effective.

‘I have given suck, and knowHow tender ’tis to love the babe that milks me:I would, while it was smiling in my face,Have plucked my nipple from his boneless gums,And dashed the brains out, had I sworn as youHave done to this.’

-Lady Macbeth (on hearing that her husbandplans to proceed no further with the murderof King Duncan).

Whilst the child has many relationships (e.g. with siblings, teachers, friends etc) the relationship between the child and the mother is of paramount importance. How our mother relates to us in our early years has a profound impact on our subsequent development and future lives, not least in terms of how we perceive ourselves and how we relate to others.

For most children, the relationship with the mother is stable, supportive and loving (although, of course, there will inevitably be the normal ups and downs, especially, frequently, during adolescence) but for a minority of children the relationship becomes deeply problematic – the mother may persistently criticize, display frequent, intense anger and hostility, put her own needs perpetually before the child’s, be emotionally abusive or emotionally unavailable, or even reject and abandon the child.

In many instances in which the maternal bond with the child has not properly developed, the mother may manipulate the child by exploiting his/her need for love and care; in other words, if the child fails to develop strategies, at great cost to him/herself, to maintain a tolerable relationship, the mother will reject the child. Indeed, the child may have this threat constantly hanging over him/her (my own mother employed this strategy, until, finally, I was forced to move out and live with my father and step-mother when I was thirteen). The child is put into a position whereby s/he must always meet the mother’s highly exacting needs or face fear of abandonment.

This problematic relationship with the mother shapes the child’s view of him/herself – s/he may have to be constantly ‘on guard’ with the mother, monitoring (either consciously or unconsciously) her minutest reactions in order to try to predict whether she is about to ‘turn’ on him/her. As the child gets older, this can lead to him/her becoming generally mistrustful of others (constantly on the look out for signs of imminent rejection and betrayal, sometimes, due to the hypervigilance learned in childhood as a survival mechanism, perceiving threats which do not, in reality, exist) which frequently leads to extreme difficulties in maintaining relationships (especially intimate relationships) with others.

BIOLOGICAL EFFECTS ON THE CHILD.

If the child is exposed to prolonged stress by a problematic relationship with the mother, this can have a PHYSIOLOGICAL EFFECT on him/her which LOWERS HIS/HER ABILITY TO COPE WITH STRESS IN LATER LIFE. The constant anxiety felt by the child INTERFERES WITH THE DEVELOPMENT OF NEUROLOGICAL (BRAIN) CIRCUITS REQUIRED FOR EMOTIONAL REGULATION. Without the normal ability to regulate emotions and ‘self-soothe’ (as it is often put in the relevant literature), the child may go on to develop PROBLEMS WITH CONTROLLING ANGER, and, without the appropriate therapy, such problems can severely blight his/her life and interaction with others.

THE ROLE OF GENES

Studies suggest that not all children are affected equally adversely by problematic interaction with the mother. A main reason for this would seem to be that some children have GENES WHICH MAKE THEM RESILIENT to difficult emotional environments, whilst others lack these PROTECTIVE GENES.

EFFECTS OF PROBLEMATIC MOTHER-CHILD INTERACTION ON THE CHILD’S DEVELOPING BRAIN.

A good bond between mother and baby starts to have effects on the baby’s brain development immediately. When shown love and care, the baby’s brain becomes flooded with ENDOGENOUS OPIATES (pleasure inducing brain chemicals).Indeed, the brain’s development is highly dependent on how the mother responds to the baby’s feelings and needs; the relationship between mother and baby will have a day-to-day BIOLOGICAL IMPACT ON THE DEVELOPMENT OF THE YOUNG BRAIN. When problems arise, NEURAL NETWORK DEVELOPMENT IS DISRUPTED; If this disruption is protracted and severe, the affected individual, as an adult, may become HIGHLY EMOTIONALLY DYSREGULATED, frequently feeling overwhelmed by ANXIETY, FEAR and ANGER. Problems, too, as a result of EARLY NEUROLOGICAL DAMAGE, will very frequently extend to significant difficulties in relation to IMPULSE CONTROL.

It has already been shown that emotional abuse in early life can lead to just as much harm as physical abuse; prolonged stress, in early life, for whatever reason, does NOT ‘toughen the individual up’; on the contrary, the biochemical effect of the severe, protracted stress makes the individual affected MUCH MORE VULNERABLE in terms of his/her ability to deal with stress in later life.

Effect Of Trauma On Young Rats’ Brains :

A recent Swiss study by Marquez et al. (2013) has looked at the effects of trauma on ‘adolescent’ rats. It was found that those rats who were exposed to trauma (fear and stress inducing stimuli) suffered adverse PHYSICAL EFFECTS ON THE BRAIN (specifically, the PREFRONTAL CORTEX). This, in turn, leads to them displaying significantly more aggressive behavior than non-traumatized rats.

Effect Of Separation From Mothers :

A very similar effect has been found to occur in young rats SEPARATED FROM THEIR MOTHERS.
Furthermore, ‘adolescent’ rats exposed to trauma also develop ANXIETY and DEPRESSION type behaviors. They were found to also have increased activity in the brain region known as the AMYGDALA (which is linked to FEAR and VIOLENCE in humans). Additionally, they developed abnormally high levels of TESTOSTERONE ( a hormone which, in humans, is linked to AGGRESSION and VIOLENCE). Even the rats’ DNA was found to be affected by the trauma (specifically, MAOA genes). These genes act to break down SEROTONIN (a brain chemical, or neurotransmitter) and damage to it leads to too much serotonin being broken down which, in turn, leads to aggressive behaviour.

Comparison With Adult Rats :

However, ADULT RATS exposed to trauma did not undergo the same behavioral changes, so:

THE RESEARCH SUGGESTS IT IS TRAUMA IN EARLY LIFE, RATHER THAN IN ADULTHOOD, WHICH HAS ESPECIALLY DEEP EFFECTS ON THE CHEMISTRY AND PHYSICAL STRUCTURE OF THE BRAIN, THAT LEADS TO A PROPENSITY FOR AGGRESSIVE BEHAVIOR.

CONCLUSION:

To what degree can we apply these findings to the effects of childhood trauma in HUMANS?

In fact, the findings I’ve outlined above mirror very accurately findings from studies on humans; this suggests that similar physiological processes are going on in both rats and humans as a result of early trauma.

Studies on non-human primates have also given rise to very similar findings.

It is hoped that such research showing that physiological effects of early trauma seem to underlie a development of a greater propensity towards violence and aggression will help lead to drugs being developed that can reverse these physiological effects and therefore reduce levels of aggression in individuals affected by early trauma. With this aim in mind, further human and non-human studies are being conducted.

Studies have shown that male children who are severely maltreated are more prone to anti-social and violent behaviour in later life. Is this due to their parents passing on ‘bad’ genes, the child growing up in a ‘bad’ environment, or a combination of the two?

A study by Moffit et al looked at how children’s genes interacted with their environment to produce (or not to produce) later anti-social behaviour.

The study focused upon one particular group of genes known as MAOA genes (MAOA is an abbreviation for the brain chemical MONOAMINE OXIDASE A).

It was found that those with high activity MAOA genes were, in the main, protected from the potential adverse effects of the problematic environment in which they were brought up:

THEIR HIGH ACTIVITY MAOA GENES MADE THEM RESILIENT AGAINST ENVIRONMENTAL INFLUENCES WHICH CAN OTHERWISE LEAD TO AN ANTI-SOCIAL PERSONALITY.

The opposite was the case for those who had low activity MAOA genes:

THOSE WITH LOW ACTIVITY MAOA GENES WERE MUCH MORE LIKELY TO DEVELOP ANTI-SOCIAL BEHAVIOUR PATTERNS IF THEY WERE MALTREATED AS CHILDREN COMPARED TO THOSE WITH HIGH ACTIVITY MAOA GENES.

In the study, those in the second group (low activity MAOA genes) commited four times as many assaults, robberies and rapes.

WHAT CAN BE CONCLUDED FROM THIS?

It seems, therefore, that PARTICULARLY BAD OUTCOMES, IN TERMS OF PROPENSITY TO DEVELOP ANTI-SOCIAL BEHAVIOUR, are much more likely if the individual in question has had BOTH a ‘bad’ childhood environment AND has inherited ‘bad’ genes (low activity MAOA genes). Indeed, it would appear that the JOINT EFFECT of BOTH is GREATER THAN THE SUM OF THE PARTS of the two factors.

This finding has been confirmed by other studies showing that low activity MOAO genes are connected with the development of anti-social behaviour.

TREATMENT IMPLICATIONS:

These findings have implications for treatment of psychological conditions associated with aggression as there are drugs which alter brain neurochemistry by acting upon monoamine oxidase. However, it should be noted that these drugs are not without risk and cannot always be guaranteed to be helpful. All treatment options require consultations with the relevant medical experts.

Childhood Trauma And Alcoholism

When childhood trauma remains unresolved (i.e. it has not yet been worked through and processed with the help of psychotherapy), alcoholism may result (together, frequently, with aggressive behaviour).

Indeed, it has been suggested that unresolved traumatic events are actually the MAIN CAUSE of alcoholism in later life. The trauma may have its roots in:

– the child having been rejected by the parent/s– too much responsibility having been placed upon the child

As would be expected, it has also been found that adult risk of both alcoholism and depression increases the greater the number of traumatic events experienced and the greater their intensity.

Children who grow up in alcoholic households have also been found to be at greater risk of becoming alcoholics themselves in adulthood, but this appears to be due to the fact that, as children with alcoholic parent/s, they are more likely to have experienced traumatic events than children of non-alcoholic parents, rather than due to them modelling their own behaviour regarding drinking alcohol upon that of their parent/s.

Furthermore, the more traumatic events experienced during childhood (of a physical, emotional or sexual nature), the more intensely symptoms of ANGER are likely to present themselves later on.

In research studies on childhood trauma, the degree of trauma experienced (and it is obviously not possible to quantify this with absolute precision) is often measured using the CHILDHOOD TRAUMA QUESTIONNAIRE (Fink et al., 1995) which identifies EMOTIONAL INJURIES and PARENTAL NEGLECT experienced during childhood and adolesence.

PSYCHODYNAMIC THEORIES view alcholism as A MEANS OF COPING WITH ANXIETY.Studies suggest that an alcoholic adult is about ten times more likely to have experienced physical violence as a child and about twenty times more likely to have experienced sexual abuse. Lack of peace in the family during childhood is also much more frequently reported by adults suffering from alcoholism, as are: EMOTIONAL ABUSE, NEGLECT, SEPARATION AND LOSS, INADEQUATE (eg distant) RELATIONSHIPS and LACK OF PARENTAL AFFECTION.

IMPLICATIONS FOR THE TREATMENT OF ADULT ALCOHOLICS:

Psychotherapy to help the individual suffering from alcoholism resolve his/her childhood trauma may improve treatment outcomes and reduce the likelihood of relapse. Further research is being conducted to help to confirm this.

ALCOHOL DEPENDENCE :

There is no precise definition of ‘alcohol dependence’, but it is generally agreed between experts that it usually includes the following features:

– a pattern of daily drinking

– being aware of a compulsion to drink alcohol

– changes in tolerance to the amount of alcohol that can be consumed (in the first stage, tolerance increases,but, eventually, tolerance actually reduces again)

– frequent symptoms of withdrawal from alcohol (commonly referred to as a ‘hangover). Symptoms of this may include : nervousness, shaking, tenseness, agitation (or feeling ‘jittery’ and ‘on edge’), feelings of tension, feelings of sickness/nausea

– finding relief from some or all of the above symptoms by consuming more alcohol

– during any periods of abstinance, finding that the features of dependence on alcohol soon re-emerge

It should be noted that individuals who are considered to have become dependent on alcohol may not have all of the symptoms noted above; however, the more symptoms one possesses, the more seriously dependent upon alcohol one is likely to be. The intensity of these symptoms of alcohol dependence will also vary considerably between individuals.

The cycle below represents the common experience of the highly dependent drinker :

STRATEGIES FOR THE REDUCTION OF ONE’S ALCOHOL INTAKE :

– cut out at least some drinking sessions (eg lunchtime drinking) and, ideally, find something else to occupy the time to act as a distraction (such as actually eating lunch!)

– avoid drinking environments / the company of people who may pressure you to drink, during periods that you have decided to stay alcohol-free

– if people who are likely to encourage you to drink cannot be avoided, plan how you will resist their influence

– add generous amounts of non-alcoholic mixers to alcoholic drinks where possible, but drink at same speed as you would if the alcohol were less diluted (or slower!)

– avoid falling into social traps that tend to encourage drinking, such as participating in a large, hard-drinking group of people who are buying ’rounds’ for one another where a ‘group mentality’ is likely to predominate

Alcohol, to put it starkly, can destroy lives (see chart below), so, if you feel you have a serious problem, it is strongly advisable to seek professional guidance and support.

Individuals with low self-esteem constantly criticize themselves. We may even META-CRITICIZE ourselves (criticize ourselves for criticizing ourselves). We oftemn focus on mistakes and over-generalize from them, believing that these mistakes completely define us as a person (thus losing perspective and ignoring the positive things about ourselves; in other words, being biased against ourselves, often because we have been programmed to dislike ourselves during childhood).

We need to question our negative beliefs about ourselves and ask ourselves: ARE WE CONFUSING OUR THOUGHTS ABOUT OURSELVES WITH THE ACTUAL FACTS? One of the biggest dangers of self-criticism is that it can PARALYZE and DEMORALIZE us, taking away our confidence to try to develop ourselves in life. We feel doomed to perpetual, unremitting failure.

We would not follow a friend around all day and focus his attention on his every little mistake by loudly announcing it to the exclusion of everything else, so why do we think it fair to do it to ourselves – undermining ourselves, chipping further away at our own precarious confidence?

CONSTANT SELF-CRITICISM IS COMPLETELY UNREALISTIC:

Often, we criticize ourselves with the benefit of hindsight – overlooking the fact that it was not possible to have this perspective at the time, and that we reacted AS THINGS APPEARED TO US THEN.

When we criticize ourselves in RETROSPECT, we do so with the benefit of information that was not available to us at the time we acted. CONSTANT SELF-CRITICISM PREVENTS US FROM LEARNING:

By constantly criticizing ourselves we take away our confidence to tackle problems in the future that could help develop us as a person; we keep ourselves ‘stuck’. We learn much better by PRAISING OURSELVES FOR WHAT WE DO RIGHT, NOT CRITICIZING OURSELVES FOR WHAT WE DO WRONG.

If we conclude we’re a hopeless failure, condemned to be eternally incompetent and useless, when we get things wrong, we will lose all incentive to perservere and make constructive changes in our lives.

CONSTANT SELF-CRITICISM IS MASOCHISTIC:

By constantly criticizing ourselves, we are kicking ourselves when we are down. We might be criticizing ourselves for such things as lacking confidence or always being miserable. It is important to remember, though, that other people, too, would probably see themselves in the same way if they had had the same experiences as us. It is a NATURAL and COMMON response to stressful events and does not mean that there is anything fundamentally wrong with us.

OVERCOMING OUR CRITICAL THOUGHTS:

-Spotting our self-critical thoughts: self-critical thoughts can become automatic, a routine we have never actively tried to change. We may not even have considered that we can change, assuming they were an essential and intransigent part of our nature.

But changing the way we think about ourselves changes the way we feel and behave, so it is necessary for us to stop being so hard on ourselves and focus much more on our positive qualities an our potential to grow as a person as we would like to.

We need to stop feeling excessive guilt and disappointment in ourselves and realize such thoughts are most probably the result of depressed, faulty self-judgments and do not accurately reflect the person we actually are.

We need to gradually distance ourselves from these erroneous, negative self-descriptions that we have, up until the time we undertake to change, imposed upon ourselves.

Challenging our negative thoughts about ourselves:

When we have negative thoughts about ourselves we can do the following:

-tell ourselves our thoughts about ourselves could be completely mistaken, unrealistic and unfair. Also, they may be caused by an irrational guilt complex and a subsequent unconscious wish to punish ourselves.

-concentrate on all the evidence AGAINST our negative view of ourselves.

-consider other perspectives: are we taking the most negative one possible?

-remind ourselves that our negative thoughts are keeping us stuck in our life situation, making us too depressed, unmotivated and lacking necessary confidence to develop our full potential and to change our lives for the better.

-remind ourselves that we are almost certainly judging ourselves too harshly; much more harshly, say, than we would judge a friend. -remind ourselves that it is irrational to write ourselves off as a person due to some past mistakes and weaknesses. -make more of our strengths and less of our weaknesses.

-stop feeling disproportionately guilty about mistakes made in relation to great stress.

A quick search of the internet reveals a very large range of therapies on offer which purport to treat BPD effectively. Indeed, the sheer range of putative treatments can seem confusing and overwhelming.

It is for this reason that I concentrate on just six treatments which research suggests are the most beneficial.

Let’s look at each of these in turn:

1) MENTALIZATION-BASED THERAPY (MBT).

My previous post on BPD referred to how people suffering from it have difficulties with how they are attached to (ie how they relate to) PRIMARY CARE GIVERS (eg parents). This can manifest itself in ATTACHMENT DISORDERS (which I also looked at in my last post) making other relationships they develop in adult life very difficult, volatile, complex, painful and distressing.

MBT seeks to help the person understand the roots of these difficulties and how their feelings and behaviours may be impacting on their relationships which in turn makes these relationships problematic.

Research shows that outcomes of MBT treatment have so far been very encouraging.

As well as reducing relationship problems, the therapy has also been found to lessen the likelihood of suicidal ideation ( thoughts and plans about suicide) and hospitalizations. Also, it has been shown to improve day-to-day functioning.

2) SCHEMA THERAPY.

Schemas are deeply entrenched beliefs relating to both oneself and the world in general. In people with BPD, these schema can be extremely negative (inaccurately so) and very unhelpful (or, to use a more technical term, MALADAPTIVE) to the individual who holds them.

Very often, they stem from a negative mindset which developed during the individual’s early life, due to, in no small part, childhood trauma. It is worth repeating that these negative schema can be very deeply ingrained and colour the individual’s entire outlook on life.

Schema therapy seeks to change these maladaptive schema into more adaptive (helpful) ones.

Treatment can be very lengthy, but there is strong evidence that it can significantly reduce symptoms of BPD.

Research into this type of treatment remains ongoing and I will report on any significant developments.

3) TRANSFERENCE-FOCUSED PSYCHOTHERAPY (TFP).

It is certainly worth first defining the psychotherapeutic idea of TRANSFERENCE:

it may be defined as: THE INAPPROPRIATE REPETITION IN THE PRESENT OF A RELATIONSHIP THAT WAS IMPORTANT TO THE PERSON’S CHILDHOOD.

For example, if our parents hurt, exploited or rejected us as children, in adult life we might feel that everyone we get to know will do the same, but without evidence that this will be the case (we are basing our view on a past relationship which is now not relevant).

The treatment aims to help individuals stop viewing present relationships in a rigid way determined by their painful past and show them that they could be misperceiving their present interactions with others ( including the therapist, as often individuals transfer the feelings they had for their parents as children -eg resentment- onto the therapist in the present).
Research, so far, has shown positive results and remains ongoing.

4) COGNITIVE THERAPY.

Cognitive therapy has long been known to be a very effective treatment for conditions such as anxiety and depression, and it is now being increasingly used to treat BPD. Studies of its effectiveness in relation to this have, so far, been encouraging.

One advantage of cognitive therapy is that it often leads to very significant improvements over quite short treatment periods. I myself underwent cognitive therapy and found it very beneficial.

Cognitive therapy focuses on correcting faulty, distorted, negative thinking styles relating to how we view ourselves, the world and the future. I write in more detail about cognitive therapy in the EFFECTS OF CHILDHOOD TRAUMA category of my blog.

5) DIALECTIC BEHAVIOUR THERAPY (DBT).

The studies on this therapy have , so far, given mixed results. It has been shown, though, in several pieces of research, to reduce the likelihood of suicide attempts in the individual undergoing treatment (the risk of suicide in people suffering from BPD without treatment is high).

Also, after a year of treatment, individuals report a more general improvement in their condition, but, unfortunately, often are still left with significant levels of distress. More studies are required, and, indeed, are being conducted to see if longer treatment periods yield better outcomes. I will report on any significant developments in this area.

DBT draws on psychotherapy, group therapy, meditation, elements of Buddhism and cognitive-behaviour therapy. More research needs to be conducted on the therapy to discover which of its varied components are the most effective in treating BPD. Again, I will report on significant developments.

6) MEDICATION.

Whilst there is, at the moment, no obvious, single medication to treat the whole range of BPD symptoms equally effectively, there are, nevertheless, established medications which can help with some of the symptoms the BPD sufferer might experience, such as anxiety and depression. This is, though, of course, the province of GPs and psychiatrists.

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Childhood Trauma And Self-Harm :

1) distracting our thoughts away from self-harm
2) reducing the intensity of our emotional arousal to levels which we are able to manage
3) dealing with internal critical ‘voices’ (ie thought processes).

However, as self-harming is often deeply ingrained, we cannot expect instantaneous results. It needs working at.

Let’s look at each of the 3 elements in turn:

1) DISTRACTION: these can be very simple things such as listening to music, watching a movie, going for a walk or a run, reading, calling a friend, browsing the internet, doing something creative like art or craft (eg making a collage), taking a bath, and keeping a journal or diary (including writing down our feelings).

2) REDUCING THE INTENSITY OF OUR EMOTIONAL AROUSAL: one way to do this is to get the painful emotion out. Again, there are simple ways to accomplish this. They include: going for a run, punching a punch bag (or even a pillow), writing a letter to, for example, our parents (without actually sending it), writing out our feelings in a journal, calling a crisis line, going to an online chatline/support group and sharing our feelings, writing poetry about how we feel, playing moving music/crying.

RELEASING ANGER SAFELY:

Sometimes our anger can overwhelm us, so it is important to be able to discharge it in a safe way. Those of us who have experienced childhood trauma have very frequently been taught to blame ourselves. This can result in remaining angry at ‘the child within us’. It is therefore necessary to realize:

a) this child did nothing wrong and does not deserve our anger.
b) the anger needs to be appropriately and safely redirected at those who caused our childhood trauma (in a way which is not destructive to ourselves or them).
c) FEELING angry is not the same as EXPRESSING anger, so does no harm: so we don’t need to fear these angry feelings.
d)we need to stop repressing or misdirecting our anger (at those who do not deserve it – known as DISPLACEMENT in psychodynamic theory) as this can lead to it becoming obsessive.
e) we need to learn to express our anger safely, appropriately and positively. For example, writing a letter we have no intention of sending in order to release our pent up feelings, taking up Judo or a martial art, role playing with a friend or counsellor ( saying to him/her what we would like to say to those who caused our childhood trauma).

SOME DOs AND DON’Ts RELATED TO ANGER:

DO:

A acknowledge anger
N nip it in the bud
G get help for your anger if necessary (eg anger management classes)
E express anger constructively
R release anger appropriately and let it go

DON’T:

A avoid it
N numb it with food/ illicit drugs/alcohol etc
G grin and grit your teeth (ie suppress it as it will just ‘fester’)
E explode
R rationalize it (ie explain it away)

3) DEALING WITH OUR INTERNAL CRITICAL ‘VOICES’: growing up with negative parents leaves many of us with a lot of negative messages running around our heads – we may have had horrible things said about us so often that we have INTERNALIZED them (ie come to see them as true so they form the basis of our self-concept). As adults, we first need to acknowledge that we have these self-lacerating thoughts. This is because the attempt to ignore them can paradoxically make them all the more intense and tenacious.

We may come to notice triggers for these thoughts. For example, if someone is just slightly off-hand with us we may feel we must be a horrible person who everyone will always reject as a matter of course. The root of this may be that we were rejected by one or both of our parents. Being able to trace our self-critical thoughts back to their roots in such a way, and, therefore, understand their triggers, can reduce their intensity of them quite considerably.

In order to retrain the way we think about ourselves, it is helpful, every time we have a negative thought about ourselves, to replace it with a positive one. It can be helpful, too, to write those positive messages down and to keep them somewhere they can easily be retrieved so that we can, on occasion, read through them. It is even possible to make an audio file of them and listen to them occasionally.

As time goes on, it is necessary to let our self-critical messages go and to stop emotionally tormenting ourselves – instead, we need to treat ourselves with compassion.

When individuals come to the point that they are ready to stop hurting themselves with self-critical messages, some make a kind of ritual out of it such as writing down all the negative thoughts they used to have about themselves on a piece of paper and then burning it or tearing it up and throwing it away.

In summary, then, we need to realize that we have absolutely nothing whatsoever to gain, for either ourselves or others, by constantly emotionally torturing ourselves. It is necessary, instead, to start treating ourselves with the love and compassion which may well have been denied us in childhood. We can give ourselves the love and compassion the child within us deserves.